Survey of intrauterine red blood cell (<scp>RBC</scp>) transfusion practices in the United States

Bakhtary, Sara; Panchalee, Tachjaree; Crowe, Elizabeth; Schwab, Marisa E.; Zakieh, Abdulhafiz; Josephson, Cassandra D.; Sobhani, Nasim C.; Gonzalez‐Velez, Juan M.; Goel, Ruchika

doi:10.1111/trf.17134

Cited by 5 publications

(9 citation statements)

References 18 publications

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“…To mitigate the risk of transfusion‐transmission of cytomegalovirus (CMV), RBCs should undergo pre‐storage leukocyte reduction (LR) via filtration (also referred to as “CMV safe”). As an additional attribute, some centers (50%; 16/32 in one survey) may choose to provide RBCs collected from CMV seronegative donors in addition to LR 6 . In the absence of high‐quality evidence of superiority with the combination approach and the limited availability of CMV seronegative donors, IUT should not be delayed when LR RBC are available 57,58 …”

Section: Rbc Component Selection and Processingmentioning

confidence: 99%

“…To ensure optimal oxygen delivery and RBC survival in fetal circulation, RBCs selected for IUT are as fresh as possible, typically less than 7 days post-collection. 6 The use of fresh RBCs may also mitigate potential metabolic adverse effects of transfusion such as hyperkalemia. Following the first IUT, the expected rate of fetal hemoglobin decline is about 0.4 g/dL/day or 1% HCT/day.…”

Section: Rbc Component Selection and Processingmentioning

confidence: 99%

“…Some centers outside of the US may even attempt to provide extended antigen matching for maternal C, c, E, e, K, Fy a , Fy b , Jk a , Jk b , S, and s antigens when feasible. 5,6,54 One study from the Leiden University Medical Center in the Netherlands found that extended matching was not feasible in approximately 50% of IUTs. 54 However, when extended antigen matched blood was used, there was a 60% decrease in alloimmunization to the matched Duffy, Kidd and S antigens compared to alloimmunization after IUT with unmatched or partly matched units.…”

Section: Rbc Component Selection and Processingmentioning

confidence: 99%

“…As an additional attribute, some centers (50%; 16/32 in one survey) may choose to provide RBCs collected from CMV seronegative donors in addition to LR. 6 In the absence of high-quality evidence of superiority with the combination approach and the limited availability of CMV seronegative donors, IUT should not be delayed when LR RBC are available. 57,58 To prevent transfusion-associated graft versus host disease (TA-GVHD), RBCs intended for IUT are irradiated.…”

Section: Washed or Supernatant Removedmentioning

confidence: 99%

“…1 There is significant variability among centers in the United States and internationally with regard to policies and procedures for performing IUT and selecting and modifying blood components. [5][6][7] Existing guidance for the provision of RBC units and their subsequent modifications reflects expert opinion, historical single-center experiences, and concerns regarding the impact of transfusion on fetal hemodynamics. Successful management with IUT relies on effective communication and collaboration among multiple disciplines.…”

mentioning

confidence: 99%

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How do we perform intrauterine transfusions?

Crowe,

Hasan,

Saifee

et al. 2023

Transfusion

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BackgroundIntrauterine transfusion (IUT) is an invasive but critical and potentially life‐saving intervention for severe fetal anemia with demonstrated improvement in outcomes. The fetus is vulnerable to hemodynamic alterations and transfusion‐related adverse events; therefore, special consideration must be given to blood component selection and modification. There is widespread IUT practice variability, and existing guidance primarily relies on expert opinion and single center experiences.Study Design and MethodsExperts in Maternal Fetal Medicine, Pediatric Hematology, and Transfusion Medicine from centers across the United States, collectively performing about 120 IUT annually, offer a multidisciplinary perspective on the performance of IUT and preparation of blood components. This perspective includes strategies for identifying an at‐risk fetus, communicating between disciplines, determining the necessary blood volume, selecting and processing blood components, documenting the procedure in medical record, and managing the neonate.ResultsIdentifying an at‐risk fetus relies on review of the clinical history, non‐invasive monitoring, and laboratory evaluation. We recommend the use of relatively fresh, group O, cytomegalovirus‐safe, freshly irradiated, red blood cells (RBC) that are Hemoglobin S negative and antigen‐negative for any maternal antibody, if indicated. These RBC units should be concentrated to remove additives and increase the hematocrit thus minimizing fluctuations in fetal volume status. The units intended for IUT should be labeled clearly and the documentation of transfusion differentiated in the maternal medical record.DiscussionAn awareness of the technical, logistical, and regulatory considerations for IUT performance will facilitate improved communication and patient care, especially when rare units of RBC are required.

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Section: Rbc Component Selection and Processingmentioning

confidence: 99%

Section: Rbc Component Selection and Processingmentioning

confidence: 99%

Section: Rbc Component Selection and Processingmentioning

confidence: 99%

Section: Washed or Supernatant Removedmentioning

confidence: 99%

mentioning

confidence: 99%

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How do we perform intrauterine transfusions?

Crowe,

Hasan,

Saifee

et al. 2023

Transfusion

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Safety of Intrauterine Transfusion Performed Beyond 34 weeks of Gestation

Youssefzadeh,

Masri,

Korst

et al. 2024

Prenatal Diagnosis

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ObjectiveTo describe (1) procedure‐related complications, and (2) gestational age (GA) at delivery in patients who received their final intrauterine transfusion (IUT) at ≥ 34 weeks 0 days versus at < 34 weeks 0 days.MethodsThis was a retrospective study of pregnancies treated with IUT. Procedure‐related complications were defined as any of the following within 48 h of IUT: (1) rupture of membranes or preterm delivery, (2) intrauterine infection, (3) fetal death, (4) fetal compromise resulting in emergency cesarean, or (5) neonatal death. Patient and procedural characteristics were described among patients with final IUT at ≥ 34 weeks 0 days and at < 34 weeks 0 days.ResultsWe studied 94 pregnancies with 237 IUTs; 35 (37.2%) had their last IUT at ≥ 34 weeks 0 days and 59 (62.8%) had their last IUT at < 34 weeks 0 days. Three procedure‐related complications occurred (1.3% of procedures, 3.2% of pregnancies). All resulted in emergency cesarean section; 1 case performed at < 34 weeks 0 days resulted in neonatal death. The remaining 2 occurred during IUT at ≥ 34 weeks 0 days. Pregnancies with the last IUT at ≥ 34 weeks 0 days delivered at a median GA of 37.1 weeks.ConclusionsComplications were rare. IUT performed at ≥ 34 weeks 0 days appeared safe.

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Immunohematological testing and transfusion management of the prenatal patient

Quraishy,

Sapatnekar

2023

Advances in Clinical Chemistry

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Survey of intrauterine red blood cell (RBC) transfusion practices in the United States

Cited by 5 publications

References 18 publications

How do we perform intrauterine transfusions?

How do we perform intrauterine transfusions?

Safety of Intrauterine Transfusion Performed Beyond 34 weeks of Gestation

Immunohematological testing and transfusion management of the prenatal patient

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